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Artificial insemination

Success rate of intrauterine (IUI)

 

The success rate of IUI varies considerably between infertility clinics and in the same clinic between different couples.Success rates are in the region of 5-30% and depend upon many factors including:

Cause of infertility

The cause of infertility is crucial in determining the success rate of any treatment undertaken.

Endometriosis

Women with severe endometriosis or men with severe sperm problem are not suitable for intrauterine insemination (IUI) because of the very low success. 

Male factor infertility

It has been reported that in male factor infertility, unstimulated (natural cycle) IUI increases the likelihood of pregnancy two-fold while stimulated IUI increases it by about five-fold. Men with severe sperm problems are not suitable for IUI because of the very low success rate.

Unexplained infertility

In unexplained infertility, unstimulated IUI increases the likelihood of a pregnancy by three-fold, while stimulated IUI increases it by about five-fold.

The female partners fertility

Women with healthy Fallopian tubes and who ovulate regularly have a higher chance of achieving a pregnancy than women whose tubes are not healthy or do not ovulate regularly.

The female partners age

The younger the woman’s age the higher the chance of conception.

Duration of infertility

The chance of conception decline with the longer period of infertility.

Sperm produced

The sperm quality and quantity, the degree of sperm motility, the percentage of normal looking sperm and the number of sperm are the most important factors. These may be assessed with a semen analysis.

Cycle rank

It is generally accepted that re-evaluation and discussion about other form of treatments such as in-vitro fertilization (IVF) and gamete intra-Fallopian transfer (GIFT) should be carried out with the couple after 6 consecutive failed treatment cycles. Because about 90% of patients who conceive by IUI will do so in the first 6 cycles, thereafter hardly increase by continuing for longer.

Steps involved in artificial insemination

Monitoring the insemination treatment

The development of follicles and endometrium (lining of the womb) is monitored by blood hormone tests and ultrasound scans. When the leading follicle measures 18-mm in diameter and the endometrium is well developed, an hCG injection is given to time insemination.

Ultrasound scan used to monitor the developing follicles produced by ovarian stimulation.

Monitoring of the cycle is essential in stimulated cycles to see whether an excessive number of follicles develop, indicating the possibility of ovarian hyperstimulation syndrome (OHHS) and high orders multiple pregnancy (triplets or more). If more than four mature follicles develop, most infertility clinics will advise you that either to withhold hCG injection abandoned the cycle and abstain from intercourse. Alternatively, convert the treatment cycle to in-vitro fertilization (IVF) or gamete intra-Fallopian transfer (GIFT) if appropriate.

Timing of insemination

Timing of insemination is crucial for successful treatment.

The precise timing of insemination is very important, IUI is done either when ovulation is imminent or just after. There are several methods available for timing insemination in natural cycles. These include; measurements of basal body temperature (least accurate method), assessment of cervical mucus (not reliable), detection of the LH surge in the urine or blood, and ultrasound scans.

Most infertility clinics time insemination in natural cycles by ultrasound scans and detection of LH surge, as these are the most accurate methods. Insemination is usually performed at 24 and 48 hours after urine LH surge. For stimulated cycles insemination is usually performed about 40 hours after hCG injection.

Insemination

Intrauterine insemination procedure. 11

This insemination procedure is simple and takes about 5-10 minutes, usually being painless. It involves insertion of a speculum into the vagina to visualize the cervix. The cervix is then cleaned with a little culture medium. The washed sperm is then injected into the cavity of the womb using a fine plastic catheter. After insemination, the patient may be asked to rest for a short period of time. Sexual intercourse can continue as normal during the treatment cycle.

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